Prescribing patterns of myopia control contact lenses among optometrists in Ireland

Purpose This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017. Methods Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practices prescribing MCCLs to myopic children 5–18 years old. In MCCL-prescribing practices, the proportion of contact lens wearing children fitted with MCCLs and the proportion of progressive (≤−0.25 D/year) myopic children fitted with MCCLs were determined. Logistic regression was used to determine which factors influenced the likelihood of being prescribed a MCCL. Results Overall, just 10 practices were found to prescribe MCCLs of any type. The Coopervision MiSight contact lens was used in 85% of all MCCL fittings with most other fits being off-label multifocals. The use of MCCLs rose from 3% of contact lens fits in 2017 to 27% in 2021. Children fitted with MCCLs were on average younger (12.2 ± 2.3 years vs. 15.4 ± 2.1 years) but more myopic (−3.46 ± 1.84 D vs. −3.03 ± 1.69 D) than those fitted with standard contact lenses. The most predictive factors for being fitted with MCCLs were year of examination (OR: 2.54, 95% CI: 2.13, 3.03), younger age (OR: 1.52, 95% CI: 1.39, 1.64) and greater myopia (OR: 1.25, 95% CI: 1.11, 1.39). Conclusion Clinician engagement in myopia management has increased in Ireland since the formal introduction of MCCLs, but more than two-thirds of practices included are yet to offer this form of myopia management. The proportion of children with progressive myopia that has been prescribed MCCLs has increased, but the majority of children are still managed for vision correction only. There is significant scope for improving the uptake of evidence-based myopia control treatments and for optimising the age and degree of myopia at which such interventions are initiated

Using electronic medical record data to establish and monitor the distribution of refractive errors

Objective To establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics. Design Retrospective cross sectional cohort study of electronic medical records (EMR). Methods Electronic medical record data was extracted from forty optometry clinics, representing a mix of urban and rural areas in Ireland. The analysis was confined to demographic and clinical data gathered over a sixty-month period between 2015 and 2019. Distribution rates were calculated using the absolute and relative frequencies of refractive error in the dataset, stratified for age and gender using the following definitions: high myopia ≤ -6.00 D, myopia ≤ -0.50 D, hyperopia ≥ +0.50 D, astigmatism ≤ -0.75 DC and anisometropia ≥ 1.00 D. Visual acuity data was used to explore vision impairment rates in the population. Further analysis was carried out on a gender and age-adjusted subset of the EMR data, to match the proportion of patients in each age grouping to the population distribution in the most recent (2016) Irish census. Results 153,598 clinic records were eligible for analysis. Refractive errors ranged from -26.00 to +18.50 D. Myopia was present in 32.7%, of which high myopia represented 2.4%, hyperopia in 40.1%, astigmatism in 38.3% and anisometropia in 13.4% of participants. The clinic distribution of hyperopia, astigmatism and anisometropia peaked in older age groups, whilst the myopia burden was highest amongst people in their twenties. A higher proportion of females were myopic, whilst a higher proportion of males were hyperopic and astigmatic. Vision impairment (LogMAR \u3e 0.3) was present in 2.4% of participants. In the gender and age- adjusted distribution model, myopia was the most common refractive state, affecting 38.8% of patients. Conclusion Although EMR data is not representative of the population as a whole, it is likely to provide a reasonable representation of the distribution of clinically significant (symptomatic) refractive errors. In the absence of any ongoing traditional epidemiological studies of refractive error in Ireland, this study establishes, for the first time, the distribution of refractive errors observed in clinical practice settings. This will serve as a baseline for future temporal trend analysis of the changing pattern of the distribution of refractive error in EMR data. This methodology could be deployed as a useful epidemiological resource in similar settings where primary eyecare coverage for the management of refractive error is well established

Association of Total Zinc Intake with Myopia in U.S. Children and Adolescents

Significance: This present study advances our knowledge on the role of lifestyle factors in myopia (short-sightedness), specifically dietary factors. It has been suggested in previous studies that lower zinc status is associated with myopia; however, this article shows no relationship between dietary zinc intake and myopia in U.S. adolescents. Purpose: It has been suggested that low zinc levels may contribute to the development of myopia. The aim of the present study is to examine, for the first time in a Western population, the association of total dietary and supplement zinc intake with myopia. Methods: A total of 1095 children/adolescents aged 12 to 19 years who participated in the U.S. National Health and Nutrition Examination Survey from 2007 to 2008 were enrolled in this study. Multivariate logistic regression analysis was performed to examine the relationship between total zinc intake and myopia after adjustment for potential confounders. In addition, the association between total zinc intake and spherical equivalent refractive error was examined in the myopia group through multiple linear regression. Results: Among study participants, 30% were found to be myopic (≤-1.00 D). Although median total daily zinc intake was lower among myopes (10.8 [10.2] mg/d) than among nonmyopes (11.1 [10.8] mg/d), the difference was not statistically significant (P = .11). In multiple logistic regression analyses, zinc and copper intakes were not significantly associated with myopia after adjustment for age, sex, body mass index, ethnicity, family income, recreational activity, copper intake, and daily energy intake (in kilocalories per day). In multiple linear regression, spherical equivalent refractive error was not associated with total zinc intake in the myopic group after adjustment for confounding factors (P = .13). Conclusions: In contrast to previous Asian studies, total zinc intake is not associated with the presence of myopia in U.S. adolescents/children

Choroidal Thickness Profiles and Associated Factors in Myopic Children

SIGNIFICANCE: This study addresses the lack of choroidal thickness (ChT) profile information available in European children and provides a baseline for further evaluation of longitudinal changes in ChT profiles in myopic children as a potential biomarker for myopia treatment and identifying children at risk of myopic progression. PURPOSE: This study aimed to investigate ChT profiles and associated factors in myopic children. METHODS: Baseline data of 250 myopic children aged 6 to 16 years in the Myopia Outcome Study of Atropine in Children clinical trial were analyzed. Choroidal thickness images were obtained using swept-source optical coherence tomography (DRI-OCT Triton Plus; Topcon Corporation, Tokyo, Japan). The macula was divided into nine Early Treatment of Diabetic Retinopathy Study locations with diameters of 1, 3, and 6 mm corresponding to the central fovea, parafoveal, and perifoveal regions. Multiple linear regression models were used to investigate determinants of ChT. RESULTS: Choroidal thickness varied across themacular Early Treatment of Diabetic Retinopathy Study locations (P \u3c .001): thickest in the perifoveal superior region (mean ± standard deviation, 249.0 ± 60.8 μm) and thinnest in the perifoveal nasal region (155.1 ± 50.3 μm). On average, ChT was greater in all parafoveal (231.8 ± 57.8 μm) compared with perifoveal (218.1 ± 49.1 μm) regions except superiorly where the ChT was greater in the perifoveal region. Longer axial length and higher myopic spherical equivalent refraction were consistently associated with thinner ChT at all locations in the multiple linear regression models. Asian race was significantly associated with thinner ChT only at parafoveal and perifoveal superior regions after Bonferroni correction (P = .004 and P = .001, respectively). CONCLUSIONS: Choroidal thickness was thinnest in the nasal macular region and varied systematically across all macular locations, with axial length and spherical equivalent refraction being the strongest determinants of ChT. Longitudinal evidence will need to evaluate whether any differences in ChT profiles are predictive of myopic progression and to determine the role of ChT measurements in identifying myopic children most in need of myopia control treatment

Regional variations and temporal trends of childhood myopia prevalence in Africa: A systematic review and meta-analysis

Purpose: To provide contemporary and future estimates of childhood myopia prevalence in Africa. Methods: A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ −0.50D; high myopia: SE ≤ −6.00D) in Africa. Population-or school-based cross-sectional studies published from 1 Jan 2000 to 30 May 2021 were included. Meta-analysis using Freeman–Tukey double arcsine transformation was performed to estimate the prevalence of childhood myopia and high myopia. Myopia prevalence from subgroup analyses for age groups and settings were used as baseline for generating a prediction model using linear regression. Results: Forty-two studies from 19 (of 54) African countries were included in the meta-analysis (N = 737,859). Overall prevalence of childhood myopia and high myopia were 4.7% (95% CI: 3.3%–6.5%) and 0.6% (95% CI: 0.2%–1.1%), respectively. Estimated prevalence across the African regions was highest in the North (6.8% [95% CI: 4.0%–10.2%]), followed by Southern (6.3% [95% CI: 3.9%–9.1%]), East (4.7% [95% CI: 3.1%–6.7%]) and West (3.5% [95% CI: 1.9%–6.3%]) Africa. Prevalence from 2011 to 2021 was approximately double that from 2000 to 2010 for all studies combined, and between 1.5 and 2.5 times higher for ages 5–11 and 12–18 years, for boys and girls and for urban and rural settings, separately. Childhood myopia prevalence is projected to increase in urban settings and older children to 11.1% and 10.8% by 2030, 14.4% and 14.1% by 2040 and 17.7% and 17.4% by 2050, respectively; marginally higher than projected in the overall population (16.4% by 2050). Conclusions: Childhood myopia prevalence has approximately doubled since 2010, with a further threefold increase predicted by 2050. Given this trajectory and the specific public health challenges in Africa, it is imperative to implement basic myopia prevention programmes, enhance spectacle coverage and ophthalmic services and generate more data to understand the changing myopia epidemiology to mitigate the expanding risk of the African population

IMI - Myopia Control Reports Overview and Introduction

With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions, validated by well-conducted clinical trials, should be appropriately and ethically applied. The International Myopia Institute (IMI) reports the critical review and synthesis of the research evidence to date, from animal models, genetics, clinical studies, and randomized controlled trials, by more than 85 multidisciplinary experts in the field, as the basis for the recommendations contained therein. As background to the need for myopia control, the risk factors for myopia onset and progression are reviewed. The seven generated reports are summarized: (1) Defining and Classifying Myopia, (2) Experimental Models of Emmetropization and Myopia, (3) Myopia Genetics, (4) Interventions for Myopia Onset and Progression, (5) Clinical Myopia Control Trials and Instrumentation, (6) Industry Guidelines and Ethical Considerations for Myopia Control, and (7) Clinical Myopia Management Guidelines

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details

Sensory control of ocular accommodation

The investigations described in this thesis have examined how, with particular reference to optical cues, the retinal image is analysed by the brain so as to generate the appropriate signals for controlling accommodation. This line of research involved behavioural studies on trained monkeys (Macaca mulatto), human psychophysical studies, mathematical analysis of the capabilities of visual neurons in detecting defocus and single unit studies in an anaesthetized preparation. The chromatic, temporal and binocular aspects of accommodation control were considered. CHROMATIC: The accuracy of accommodation in monkeys was found to be reduced in the absence of chromatic cues. The nature of the neural processing that might be involved in utilising chromatic cues to accommodation was investigated, both theoretically and electrophysiologically, and a specific neural model was constructed. TEMPORAL: The effects on human accommodation of varying the temporal parameters of simple grating stimuli were investigated. These experiments provided information about both the sensory mechanisms involved in accommodation control and the possible role of temporal cues to accommodation. The temporal variability of accommodation (and accommodative-vergence) were examined in the rhesus monkey. BINOCULAR: The nature of the binocular interactions in accommodation control were investigated, in both man and monkey, by presenting conflicting blur cues to the two eyes and recording the accommodation response. In the presence of such conflicting cues, the accommodative response was best described as a weighted average of the inputs to the two eyes. In addition to providing insights into the sensory guidance of accommodation, these studies have also permitted a detailed comparison of accommodative function in man and the rhesus monkey. There was a striking similarity between these two species in all areas studied; ie. role of chromatic cues, temporal variability and nature of binocular interactions. Thus the rhesus monkey appears to be an excellent experimental model for investigating the accommodation control system.</p